| Grosse Dmd Inc. | |
|
3939 W Fullerton Ave Chicago IL 60647-2243 | |
| (773) 235-0000 | |
| Not Available |
| Full Name | Grosse Dmd Inc. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 3939 W Fullerton Ave, Chicago, Illinois |
| Authorized Official Name and Position | Gina Leigh Grosse (GENERAL DENTIST) |
| Authorized Official Contact | 3094720645 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grosse Dmd Inc. 849 N Franklin St Unit 1104 Chicago IL 60610-8793 Ph: (309) 472-0645 | Grosse Dmd Inc. 3939 W Fullerton Ave Chicago IL 60647-2243 Ph: (773) 235-0000 |
| NPI Number | 1609176999 |
|---|---|
| Provider Enumeration Date | 11/02/2010 |
| Last Update Date | 11/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609176999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019027794 (Illinois) | Primary |
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